Abstract
Lymphoma is the third most common paediatric cancer. Early detection of high-risk patients is necessary to anticipate those who require intensive therapy and follow-up. Current literature shows that residual tumor avidity on PET (Positron Emission Tomography) following chemotherapy corresponds with decreased survival. However, the value of metabolic parameters has not been adequately investigated. In this retrospective study, we aimed to evaluate the prognostic value of metabolic and other parameters in paediatric and adolescent Hodgkin lymphoma. We recorded tMTV (total Metabolic Tumor Volume), TLG (Total Lesion Glycolysis), and SUVmax (maximum Standard Uptake Value) on baseline PET, as well the presence of bone marrow or visceral involvement. HIV (human immunodeficiency virus) status and baseline biochemistry from clinical records were noted. All patients received stage-specific standard of care therapy. Response assessment on end-of-treatment PET was evaluated according to the Deauville criteria. We found that bone marrow involvement (p = 0.028), effusion (p < 0.001), and treatment response (p < 0.001) on baseline PET, as well as HIV status (p = 0.036) and baseline haemoglobin (p = 0.039), were significantly related to progression-free survival (PFS), whereas only effusion (p = 0.017) and treatment response (p = 0.050) were predictive of overall survival (OS). Only baseline tMTV predicted treatment response (p = 0.017). This confirms the value of F-18 FDG PET/CT (Fluoro-deoxy-glucose Positron Emission Tomography/Computed Tomography) in prognostication in paediatric and adolescent Hodgkin lymphoma; however, further studies are required to define the significance of metabolic parameters.
Highlights
IntroductionDespite the aggressive nature of most paediatric lymphomas, advances in management with a combination of chemotherapy and targeted radiation therapy have resulted in favorable outcomes, with 5-year survival rates reported at 95% and 78% for Hodgkin lymphoma (HL) and non-Hodgkin lymphomas (NHL), respectively [2]
Lymphoma is the third most common paediatric malignancy, superseded only by leukemia and central nervous system tumors [1,2]. They account for approximately 12% of all childhood cancers, of which about 40% are represented by Hodgkin lymphoma (HL), while the remaining 60% comprise a diverse group of lymphoid malignancies, the non-Hodgkin lymphomas (NHL) [2,3,4]
Our study aimed to evaluate the prognostic value of tMTV and TLG on baseline F-18 FDG PET/CT imaging in predicting metabolic response to treatment, overall survival, and progression-free survival in paediatric Hodgkin lymphoma
Summary
Despite the aggressive nature of most paediatric lymphomas, advances in management with a combination of chemotherapy and targeted radiation therapy have resulted in favorable outcomes, with 5-year survival rates reported at 95% and 78% for HL and NHL, respectively [2]. In view of these improvements in survival, current interest has shifted to reducing treatment-related sequelae, which include secondary malignancies and cardiovascular events [1,3,4]. Another consideration in the context of a resource-limited developing country is the additional burden of diseases such as the human immunodeficiency virus (HIV), which may result in delayed and altered clinical presentation and poor treatment response [5]
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